Monday, January 19, 2015

Author: Isaac Porter
Shingles is caused by a reactivation of the varicella zoster virus that originally causes chickenpox. Fortunately, a vaccine is available to decrease the chance of shingles.

Welcome to A State of Sight, I’m Isaac Porter, MD and this is your update in ophthalmology and eye care from Raleigh. In this episode, I would like to discuss the shingles vaccine because shingles can cause a lot of eye problems when there is an outbreak around the eye. This includes inflammation, pain, scarring, or clouding of the cornea which can interfere with vision.

If you look back to A State of Sight #73, I cover more details about the shingles virus and the problems it can cause around the eye. Today I would like to go into more detail about the vaccine that is available for shingles.

You may have seen commercials recently about the shingles vaccine explaining that if you have already had chickenpox then the virus already lives inside of you. Now this is a little bit scary, and of course it’s marketing, but it’s completely true. This virus that causes chickenpox is the varicella zoster virus (or herpes zoster virus). It can live in the sensory nerves and then come out in a reactivation along one of the nerves.

With this outbreak, if it goes to V1 nerve (ophthalmic nerve, one of the branches of the trigeminal nerve), it will cause a rash in the V1 distribution, from the head, to the forehead, to the eye, and down the side of the nose. When we see this, we are concerned about eye problems. Fortunately, the vaccine is effective in preventing outbreaks of shingles.

It’s not 100% effective as the studies show it is maybe 50 - 70% effective and we aren’t sure about the long term effectiveness since it’s been available since 2006. After 5 years it appears that the effectiveness decreases.

At this time, the vaccine is available for people 50 and over, as that’s when we tend to see shingles, although we can see it in people in their 20’s or even younger. It’s more common in older people. We hope since there is a chickenpox vaccine that children are receiving now, in the future they will not have the chance to have shingles since they have never had chickenpox.

With that, they are not exposed to the virus so it doesn’t have a chance to recur in them. However, since we are not naturally being exposed to the virus as these children are growing up, we do not get natural boosters to our immunity We wonder if the incidence of shingles may go up as time goes by.

If you have any questions about this vaccine or shingles virus and how it may affect the eye, please post as we will be happy to answer them. Hopefully see you again soon in A State of Sight.